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� S ' I APPLICATION FOR SANITATION PERMIT Permit No. ---•--- (Complete in Duplicate) Date Issued ..-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i . JOB ADDRESS AND LOCATION....... -_4006__8..--Mi ler__Ave..Becktonf---C1i±•----------------------- ------ Owner s Name-------XPt}3 S__T*•_Cl`�-------------•---------------------------------- ----------------- ----------------------------------------- Phone- - "65--------------------- - 4006 S. Miner Ave. Stockton, Calif. Address--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- Contractor's --------------------------------------------------------•------------------------ Phone---9-9607-------------- Installation will serve: Residence ® ; Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--- Number of bedrooms ____Z_ Number of baths 3-_____ Lot size PZ'__g-_9_7_--T Water Supply: Public'-system ❑ Community system ❑ Priva.te (j, Depth to Water Table---*5_ ft. Character of soil,to a depth of 3 feet: Sand ❑ Grave[ ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(R: -Hardpan ❑`. Previous Application Made: Yes ❑ No F] New Construction: Yes ❑ No f!] A&UtiOnal Dl°ai.nage.. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perrmitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material__________-_____-------_----____-_-__-_-________- ❑ No, of compartments--------------------------Size_________________------------ _ Liquid depth__________ __- _---- ____CaPacitY----------------------- ^_ Disposal Field: Distance from nearest well-------501--_Distance from foundation-_--30 ---------Distance to nearest lot line____!________ Number of lines------------1--------------------Length of each line-------5}t----------------Width of trench-----NO----------------------- Type of filter materiaQj"__RQj*------Depth of filter. material___-�.21-----------Total length---------551__________________________ 3 Seepage Pit: Distance to nearest well-- --------- ------Distance from foundation--------------------Distance to nearest lot line____________.---. ❑ Number.of pits---`------------------.Lining material-----------------------Size: Diameter------------------------Depth-----------_-------.------------- I Cesspool: Distance from nearest well-----------------Distance from foundation______=`____-_------Lining material_______________________________•-.___. ❑ Size: Diameter---I--------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: . Distance from nearest well _ _ ----------------------------------------- __-__. ________________________ _-____________-Distance from nearest building ❑ Distance to neareast lot line-------------- -----------------------------------------7----------------7----------------------------------------------------------------- 1 Remodeling and/or repairing (describe):----Aar --------- •---------------------------•---------------------------------------------------------------------••---------------------------------------------------------------------___------ F - ----•-----------------------• -----------------•------------•-•-----------------------------------------------------------------------------...................--------------------•-----------.- ------ ---------... i I hereby certify that I have prepared this application and that the work will be done-in accordance with San Joaquin County ordinances, State laws, and rules and regulations.of the San-Joaquin Local Health District. (Signed) D.A. P&rY' & * --------------------------------------------------- - (Owner and/or Contractor) a -------------------------------------- By:-- ; Y' 49aJ --------- (Title) F'�$fii1A8�it?T (Plot plan, showing size of lot, location of system in relation to we s, buildings, etc., can be placed on reverse side). i T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------. +--- - -------- ----- �. ..� DATE---------------------------------------------------------- REVIEWED BY------------------------------------- - -- - DATE '" ar '� %.,# - -------------- i/-1 --------- --------- BUILDING PERMIT ISSUED------- DATE-- Alterations and/or recommendations------------------------------------------------------------------ ------------------------------------------------------------------------------------------- --- -------------------------------------------- --------------- --------------------------- ----------------------- --------------------------------------------------------------------------------- x -----------------------------_--------------------_-----------------_>-------------------------------------------------------------------------�__.----------------------------------------------------------------------------- . --------------------------------- -- -------------- - - -- --------=�------------ ----------- FINAL 1N 'SPECTION BY:-------- - - --------------------------------------- Date-------------------- - ----- --------- -------- e SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 Idarfh "C" Sfreet Stockton, California i Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100